DSA联合超声引导下治疗体表静脉畸形的临床观察

  目的  比较数字减影血管造影(DSA)联合超声引导下与单纯超声引导下治疗体表静脉畸形的有效性与安全性。  方法  回顾2012年1月—2020年12月蚌埠医学院第一附属医院整形科收治的30例体表静脉畸形患者，通过影像引导直接经皮穿刺注射硬化剂的治疗资料。根据超声和磁共振检查结果将病例分成A、B 2组，A组为空洞型病灶，周围无重要血管神经。B组为扩张型病灶，病灶较深或毗邻重要神经血管及骨骼。A组共19例，男性6例，女性13例，年龄为25(6，32)岁，选择单纯超声引导下进行治疗。B组11例，男性4例，女性7例，年龄为17(11，54)岁，采用DSA联合超声引导下治疗。治疗后随访3~12个月，比较2组的临床效果及术后不良反应情况。  结果  A组19例，3例治愈，10例明显缓解，5例部分缓解，1例无效，总有效率为94.7%(18/19)，治愈率为15.79%(3/19)，每例平均注射2.40次；B组11例，6例治愈，2例明显缓解，3例部分缓解，0例无效，有效率为100.00%，治愈率为54.55%(6/11)，每例平均注射1.37次。主要不良反应为局部软组织肿胀疼痛，给予局部冰敷、改善微循环、静滴地塞米松等对症处理后，不适症状缓解。无肺栓塞或心脑血管意外等危及生命的严重并发症，未发现肉眼血尿或血红蛋白尿。  结论  在影像引导下, 应用聚桂醇联合平阳霉素治疗体静脉畸形，是一种安全有效的治疗方法。对于病灶最大直径>5 cm的畸形静脉，使用超声联合DSA引导下治疗，治愈率更高。 

Clinical observation of DSA combined with ultrasound-guided treatment of body superficial venous malformation

  Objective  To compare the efficacy and safety of digital subtraction angiography (DSA) combined with ultrasound-guided therapy in the treatment of superficial venous malformations.  Methods  Thirty cases of superficial venous malformation admitted to the Department of Orthopaedics of the First Affiliated Hospital of Bengbu Medical College from January 2012 to December 2020 were retrospectively treated with ultrasound-guided direct percutaneous puncture injection of sclerotherapy. According to the results of ultrasound and magnetic resonance examination, the patients were divided into group A and group B. Group A had cavitary lesion with no important peripheral blood vessels and nerves. In group B, the lesions were dilated, which were deeper or adjacent to important neurovascular and skeletal lesions. A total of 19 patients, including 6 males and 13 females, with an average age of 25 (6, 32) years, were enrolled in group A. In group B, 11 patients, including 4 males and 7 females, with an average age of 17 (11, 54) years, were treated with DSA combined with ultrasound guidance. After treatment, the patients were followed up for 3-12 months to compare the clinical effects and postoperative adverse reactions between group A and group B.  Results  In group A, 3 cases were cured, 10 cases had significant remission, 5 cases had partial remission, and 1 case was ineffective. The total effective rate was 94.7%(18/19), and the cure rate 15.79%(3/19). An average of 2.40 injections were given. In group B, 6 cases were cured, 2 cases had significant remission, 3 cases had partial remission, and 0 cases were ineffective. The effective rate was 100.00%, and the cure rate was 54.55%(6/11). Each patient was injected 1.37 times on average. The main adverse reactions were local soft tissue swelling and pain. After symptomatic treatment, such as local ice compress, improvement of microcirculation and intravenous dexamethasone, the symptoms were relieved. No serious complications such as pulmonary embolism or cardio-cerebrovascular accident were found, and no gross haematuria or haemoglobinuria was found.  Conclusion  Under imaging guidance, the application of lauromacrogol combined with pingyangmycin in the treatment of somatic venous malformations is a safe and effective method. For malformed veins with the largest diameter of the lesion >5 cm, DSA-guided treatment can result in higher cure rate.